Decision Making and Confidentiality

¶ … Ethical Decision

Nursing professionals have to make routine decisions bearing ethical principles and regulations in mind. Proper decision-making necessitates a grasp of the interface between nursing, laws, and ethics (Furlong, 2007, p. 29). But nursing professionals across the world face increasing difficulty when attempting to work with integrity amid the complicated ethical decisions and pressure they encounter. "Notes on Nursing" by Florence Nightingale describes the ethical obligations of communication, confidentiality, and the importance of fulfilling patient requirements (Ulrich et al., 2010)

Ethical / Moral Issue

Karen, a nurse practitioner (NP) fresh out of college, working in a little town, is visited by a first-time expectant mother (previous menstrual period -- 5 weeks ago), Susan Ruttley, aged 29 years. Karen wishes to begin prenatal care for the patient, who, although married, visits alone and claims she hasn't informed her husband of her condition, as he wished to postpone starting a family, owing to financial problems. As part of normal screening, the NP recommends testing her for HIV. But Susan declines, claiming the couple was tested six years back (a short while prior to their wedding) and have remained mutually monogamous for 8 years. Many weeks on, Karen is visited by a certain John Ruttley whose reason for visiting is his recurrent thrush, for which he had already obtained treatment half a year ago. He claims he was diagnosed HIV+ five years ago, that is wife is aware of his condition, and that the couple always has protected sex. John claims he visits a large-town infectious disease expert for his condition, and the expert recommended instant treatment, back home, for his symptom recurrence. When John leaves, Karen looks into Susan's chart, confirming he is her pregnant patient's husband (Kaplan, 2016).

Ethical and Moral Dilemma

The above example is one kind of ethical quandary encountered by NPs. Ethics codes guide them with regard to ethically-sound decision-making, but inherently fall outside explicit guidelines for wrong and correct actions. In case of John and Susan Ruttley, the conflicting decisions faced by the NP are: treating John with the required legal and professional confidentiality standards, versus warning Susan about her possibly being infected with HIV (Kaplan, 2016).

Comparison of Health Issue with State Health Laws and Regulations

The focus of ethical reflection is, usually, an analysis of previous cases having identical competing claims. Tarasoff v. California University Regents is a famous case involving confidentiality against an obligation to warn. Here, the legal and moral patient confidentiality right was upheld, leading to a predictable and unnecessary second-party death. The Supreme Court of California State gave the ruling that healthcare providers are duty-bound to provide warning in particular situations (Kaplan, 2016). As maintained by Wallach and Levine (2002), if, during therapy, practitioners feel any client poses a threat to another individual, they are duty-bound, morally as well as legally, to provide a warning to the potential victim (cited in Corbin, 2007).

The legal and professional duty of maintaining confidentiality, grounded in the autonomy principle, isn't easily overruled. In John and Susan Ruttley's case, upon deliberation, one may conclude that a greater duty for the NP is warning Susan of the threat of HIV.

Ethical Decision-making

Exploring the case's underlying principle is a good means of resolving ethical quandaries. Beneficence (doing good for others), autonomy (respecting people), justice (fair resource and service allocation) and non-maleficence (not causing harm) are typically quoted in ethical discussions. The U.S. public regards autonomy as a more dominant value compared to other values. The utilitarian approach is a second ethical approach to decision-making, entailing appraisal of all alternatives for anticipated outcomes and ascertaining which option leads to "the greatest good." (Kaplan, 2016)

John and Susan Ruttley's case involves potential untreated HIV in Susan. Masking her husband's HIV status would prevent Susan from informed decision-making about continuing her pregnancy or aborting. Her choices can maximize or minimize chances of vertical foetal transmission. Meanwhile, safeguarding John's confidentiality will compromise both Susan and the unborn child, whose protection is just as important (Kaplan, 2016).